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菲律宾甲状腺细针穿刺抽吸物诊断为意义不明确的非典型病变的临床管理

Clinical management of thyroid aspirates diagnosed as atypia of undetermined significance in the Philippines.

作者信息

Abelardo Agustina D, Sotalbo Karen Cybelle J

机构信息

Department of Pathology College of Medicine, University of the Philippines Manila, Manila, Philippines.

Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines.

出版信息

Gland Surg. 2020 Oct;9(5):1788-1796. doi: 10.21037/gs-20-426.

Abstract

Although the cytologic criteria of atypia of undetermined significance (AUS) are defined in The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), there is heterogeneity in its prevalence, utilization, interpretation, and management. To determine the current practices of physicians of various specialties in the management of thyroid lesions reported as AUS in fine-needle aspirates in the Philippines, a survey consisting of eighteen questions was sent to physicians of varied specialties. Survey questions included geographical location of practice, type of practice (whether in a private or government setting or with academic affiliation), annual patient load, primary operator of fine-needle aspiration (FNA), number of procedures performed, method used, whether by palpation or with ultrasound-guidance, pre-procedure requirements, request for rapid on-site evaluation (ROSE), awareness and utilization of thyroid image reporting and data system (TI-RADS), knowledge of cytologic preparation of aspirates, utilization of TBSRTC nomenclature in the workplace, number of AUS that turned out benign, number of AUS that turned out malignant, management of AUS cases in the setting of patient and physician, utilization of frozen section, implication of surgery over repeat FNA. There were seventy four respondents composed of 20 (27%) otorhinolaryngologists, 15 (20%) pathologists, 14 (19%) endocrinologists, 13 (18%) radiologists, and 12 (16%) general surgeons, practicing in different institutions, with majority (58%) of the respondents based in the National Capital Region. AUS report was encountered by 58 respondents (78%) in up to 10% of their cases, eight respondents (11%) had AUS report in up to 20% of their cases and only one respondent (1%) had AUS report in more than 30% of the cases. Seven (10%), who were mainly radiologists, did not answer the question. Thirty nine physicians (53%) conservatized management with medical follow up and repeat FNA within the time frame prescribed in the Bethesda system, 11 (15%) referred patients with AUS for surgery, 16 (22%) had varied comments. Eight (11%) respondents, who were mainly radiologists, did not answer the question. The data shows that the approach to management of AUS is heterogenous amongst physician-specialists, although, majority of clinicians adhere to the practice guidelines of the American Thyroid Association. Deviation to the guidelines occur since approach to management of patients is individualized.

摘要

虽然《甲状腺细胞病理学报告贝塞斯达系统》(TBSRTC)中定义了意义不明确的非典型性(AUS)的细胞学标准,但其在患病率、应用、解读和管理方面存在异质性。为了确定菲律宾不同专科医生对细针穿刺抽吸报告为AUS的甲状腺病变的管理现状,向不同专科的医生发送了一份包含18个问题的调查问卷。调查问题包括执业地理位置、执业类型(是在私立、政府机构还是有学术附属关系)、年度患者量、细针穿刺抽吸(FNA)的主要操作者、执行的操作数量、使用的方法(是触诊还是超声引导)、术前要求、快速现场评估(ROSE)的需求、甲状腺影像报告和数据系统(TI-RADS)的知晓和应用、对抽吸物细胞制备的了解、工作场所对TBSRTC命名法的应用、结果为良性的AUS数量、结果为恶性的AUS数量、在患者和医生背景下对AUS病例的管理、冰冻切片的应用、手术与重复FNA的意义。共有74名受访者,其中20名(27%)为耳鼻喉科医生,15名(20%)为病理学家,14名(19%)为内分泌学家,13名(18%)为放射科医生,12名(16%)为普通外科医生,他们在不同机构执业,大多数受访者(58%)位于国家首都地区。58名受访者(78%)在其病例中高达10%遇到过AUS报告,8名受访者(11%)在其病例中高达20%遇到过AUS报告,只有1名受访者(1%)在超过30%的病例中遇到过AUS报告。7名(10%)主要是放射科医生的受访者未回答该问题。39名医生(53%)采取保守管理,在贝塞斯达系统规定的时间范围内进行医学随访和重复FNA,11名(15%)将AUS患者转诊进行手术,16名(22%)有不同意见。8名(11%)主要是放射科医生的受访者未回答该问题。数据显示,尽管大多数临床医生遵循美国甲状腺协会的实践指南,但不同专科医生对AUS的管理方法存在异质性。由于对患者的管理方法是个体化的,所以会出现偏离指南的情况。

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